The Foot and Ankle Disability Index (FADI) Score and Sports Module

Patient Name: _________________________________________ Date: __________

Please answer every question with one response that most closely describes your condition within the past week by marking the appropriate number in the box. If the activity in question is limited by something other than your foot or ankle, mark N/A. 0 1 Unable to do Extreme difficulty Standing Walking on even ground Walking on even ground without shoes Walking on uneven ground Stepping up and down curves Sleeping Walking initially Walking approximately 10 minutes Home responsibilities Personal Care Heavy work (push/pulling, climbing, carrying) Sports Module: Running Landing Cutting, lateral movements Ability to perform activity with your normal technique Jumping Squatting and stopping quickly Low-impact activities Ability to participate in your desired sports as long as you would like 2 3 Moderate difficulty Slight difficulty 4 No difficulty

Walking up hills Walking down hills Going up stairs Going down stairs Squatting Coming up to your toes Walking 5 minutes or less Walking 15 minutes or greater Activities of Daily Living Light to moderate work (standing, walking) Recreational activities

Pain related to the foot and ankle: 0 Unbearable 2 1 Severe Pain 3 General level of pain Pain during your normal activity

Moderate Pain Mild Pain

No Pain

Pain at rest Pain first thing in the morning

Office Use Only: Score: ____/136 points (FADI 104 points & SPORTS 32 points; No Disability 136) Number of PT Sessions: _____ Gender: M F Age: _____ ICD-9 Code: PT Initials:

The Foot and Ankle Disability Index (FADI) Score and Sports Module
Reference for Score: Martin, R. L., Burdett, R. G., Irrgang, J. J. (1999). Development of the Foot and Ankle Disbaility Index (FADI). J Orthop Sports Phys Ther, 29: http://www.orthopaedicscore.com/scorepages/foot_and_ankle_disability_index_fadi.html retrieved 02/08/2010

Hale, S. A., & Hertel, J. (2005). Reliability and Sensitivity of the Foot and Ankle Disability Index in Subjects with Chronic Ankle Instability. J Athl Train, 40(1):35-40. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1088343/?tool=pubmed retrieved 02/08/2010 Intraclass correlation coefficient (ICC) at one week: FADI 0.89, FADI Sport 0.84 Objective: assess functional limitations related to foot and ankle conditions. Diagnosis: chronic ankle instability (CAI) The FADI and FADI Sport are 1) reliable in detecting functional limitations in subjects with chronic ankle instability, 2) sensitive to differences between healthy subjects and subjects with CAI, and 3) responsive to improvement in function after rehabilitation in subjects with CAI. Ankle sprains account for 15-45% of all sports injuries. 10-30% of these athletes will develop CAI. Total Possible points: 136 (FADI 104 points & SPORTS 32 points) Lower the number the greater the disability

MDC: ?